| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $218.08 | $218.08 | $8,500.00 | |
Aetna
| Facility | 52 | $109.04 | $109.04 | $109.04 |
Medica
| Facility | $218.08 | $293.89 | $640.61 | |
United
| Facility | $1,980.00 | $1,980.00 | $1,980.00 |